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Travel Vaccines & Malaria Information, by Country

The following pages present country-specific information on yellow fever vaccine requirements and recommendations, malaria transmission information and prophylaxis recommendations, and general recommendations for other vaccines to consider during the pre-travel consultation. Reference maps of 13 countries and 10 country-specific maps of malaria transmission areas are included to aid in interpreting the recommendations. The information was accurate at the time of publication; however, this information is subject to change at any time as a result of changes in disease transmission or, in the case of yellow fever, changing country entry requirements. Updated information, reflecting changes since publication, can be found in the online version of this book (www.cdc.gov/yellowbook) and on the CDC Travelers’ Health website (www.cdc.gov/travel).

Yellow Fever

Country-specific yellow fever vaccination recommendations were changed substantially after the 2010 edition of CDC Health Information for International Travel; however, they have remained essentially the same since the 2012 edition. From 2008 through 2010, CDC, the World Health Organization (WHO), and other yellow fever and travel medicine experts reviewed available data and revised the criteria and maps that describe the risk of yellow fever virus (YFV) transmission. Based on the review, updated recommendations were made for Argentina, Brazil, Colombia, Democratic Republic of the Congo, Ecuador, Eritrea, Ethiopia, Kenya, Panama, Paraguay, Peru, São Tomé and Príncipe, Somalia, Tanzania, Trinidad and Tobago, Venezuela, and Zambia.

The review process also resulted in the creation of 3 categories of recommendations regarding yellow fever vaccination. See Table 3-26 for definitions of these recommendation categories. Note: The format of the yellow fever maps (Maps 3-16 and 3-17) depicts country-specific vaccination recommendations rather than yellow fever risk.

Ultimately, the clinician’s decision whether or not to vaccinate any traveler must take into account the traveler’s risk of being infected with YFV, country entry requirements, and individual risk factors for serious adverse events after yellow fever vaccination (such as age and immune status). For a thorough discussion of yellow fever and guidance for appropriate vaccination, see the Yellow Fever section earlier in this chapter.

Malaria

The recommendations for malaria prevention include estimates of malaria risk to US travelers. These estimates are based on numbers of malaria cases reported in US travelers and the estimated volume of travel to these countries. In some instances, the risk may be low because the actual intensity of transmission is low in that country. In other instances, significant malaria transmission may occur only in small focal areas of the country where US travelers seldom go. Thus, even though the risk for the average traveler to that country may be low, the risk for the rare traveler going to the areas with higher transmission intensity will be higher. For some countries rarely visited by US travelers, insufficient information exists to make a risk estimate. Information about malaria species present in each country is based on the best available data from multiple sources.

Several medications are available for malaria chemoprophylaxis. When deciding on which drug to use, clinicians should consider the specific itinerary, length of trip, cost of the drugs, previous adverse reactions to antimalarials, drug allergies, and medical history.

For a thorough discussion of malaria and guidance for appropriate prophylaxis, see the Malaria section earlier in this chapter.

Other Vaccines to Consider

As with all parts of the pre-travel consultation, vaccine recommendations need to be individualized after a comprehensive risk assessment, taking into account both the traveler and the trip. The list of vaccines for each country under “Other Vaccines To Consider” is meant to outline those that the clinician should consider during the pre-travel consultation; the listed vaccines are not absolute recommendations. Refer to the corresponding disease sections earlier in this chapter for more in-depth discussions.

In the list you may see any combination of the following entries:

Routine vaccines: Recommended for all travelers. These vaccines include age-specific routine vaccines, such as measles-mumps-rubella (MMR), tetanus-diphtheria-pertussis (Td/Tdap), poliovirus, varicella, and seasonal influenza. Refer to the age-appropriate immunization schedule at www.cdc.gov/vaccines/schedules for further details.

Hepatitis A: Routinely recommended for US children; recommended for travelers to countries with high or intermediate hepatitis A endemicity; may be considered for all travelers.

Hepatitis B: Routinely recommended for US children, health care workers, and for people of any age with high-risk behaviors; recommended for travelers to countries with high or intermediate prevalence of chronic hepatitis B. Vaccination may be considered for all international travelers, regardless of destination, depending on the traveler’s behavioral risk as determined by the provider and traveler.

Typhoid: Recommended for travelers to areas with increased risk of exposure, especially in smaller cities, villages, or rural areas and for more adventurous eaters.

Adult polio: Recommended for adults as a one-time booster or to complete a primary series if traveling to countries with active poliovirus circulation (i.e., ongoing endemic circulation, active polio outbreaks, or environmental evidence of active wild poliovirus circulation). An adult IPV booster dose is also recommended for certain travelers to some countries that border areas with active poliovirus circulation, based on evidence of historical cross-border transmission. The recommendations for countries bordering areas with active poliovirus circulation apply only to travelers with a high risk of exposure to someone with imported wild poliovirus infection, including those working in health care settings, refugee camps, or other humanitarian aid settings. (Updated August 27, 2013)

Meningococcal: Routinely recommended for certain ages and risk groups in the United States. Recommended for travelers to the meningitis belt of Africa during the dry season (December–June) and in other countries during an outbreak. The recommendation for vaccination may also be limited to certain regions of a country; see Map 3-11 for details. Required for travelers to Saudi Arabia for the Hajj pilgrimage.

Japanese encephalitis: Recommended for travelers staying for ≥1 month in endemic areas during the Japanese encephalitis virus transmission season and should be considered for those staying for <1 month who are at increased risk because of their activities or itineraries (such as prolonged outdoor exposure in rural areas or staying in accommodations without air conditioning, screens, or bed nets).

Rabies: Preexposure rabies vaccine may be recommended for certain international travelers based on the prevalence of rabies in the country to be visited, the availability of appropriate antirabies biologics, intended activities, and duration of stay. Refer to corresponding footnotes for additional details.

Vaccination recommended for all travelers ≥9 months of age to areas with endemic or transitional yellow fever risk, as determined by persistent or periodic YFV transmission.

Generally not recommended

Vaccination generally not recommended in areas where the potential for YFV exposure is low, as determined by absence of reports of human yellow fever and past evidence suggestive of only low levels of YFV transmission. However, vaccination might be considered for a small subset of travelers who are at increased risk for exposure to YFV because of prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites.

Not recommended

Vaccination not recommended in areas where there is no risk of YFV transmission, as determined by absence of past or present evidence of YFV circulation in the area or environmental conditions not conducive to YFV transmission.

Abbreviation: YFV, yellow fever virus.

Country-Specific Information

Display only:

Somalia

Yellow Fever

Requirements: Required if traveling from a country with risk of YFV transmission.1

Other Vaccines to Consider

FOOTNOTES

Yellow Fever1 The official WHO list of countries with risk of YFV transmission can be found in Table 3-21. Proof of yellow fever vaccination should be required only if traveling from a country on the WHO list, unless otherwise specified. The following countries, containing only areas with low potential for exposure to YFV, are not on the WHO list: Eritrea, São Tomé and Príncipe, Somalia, Tanzania, Zambia.2 An elevation of 2,300 m is equivalent to 7,546 ft.

Malaria3 The estimated relative risk value for Afghanistan is based largely on cases occurring in US military personnel who travel for extended periods of time with unique itineraries that likely do not reflect the risk for the average US traveler.4 Refers to P. falciparum malaria unless otherwise noted.5 Primaquine can cause hemolytic anemia in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Patients must be screened for G6PD deficiency before starting primaquine.

Rabies6 Canine rabies and bat lyssavirus present. Rabies also present in other mammals. Vaccine recommended for the following groups:

Travelers involved in outdoor and other activities that might bring them into direct contact with dogs, bats, and other mammals (such as campers, hikers, bikers, adventure travelers, and cavers).

Those with occupational risks (such as veterinarians, wildlife professionals, researchers).

Long-term travelers and expatriates.

Children are considered at higher risk; consider lower threshold for vaccination.

7 Bat lyssavirus and rabies in other mammalian carnivores present. Canine rabies present but not a significant concern to travelers. Vaccine is recommended only for the following groups:

Travelers involved in outdoor and other activities in remote areas that might bring them into direct contact with dogs, bats, and other mammals (such as adventure travelers and cavers).

Those with occupational risks (such as veterinarians, wildlife professionals, researchers).

Long-term travelers and expatriates visiting remote areas.

Children are considered at higher risk; consider lower threshold for vaccination.

8 Bat lyssavirus and rabies in other mammalian carnivores present. Canine rabies is not present. Vaccine is recommended only for the following groups:

Travelers involved in outdoor and other activities in remote areas that might bring them into direct contact with bats and other mammals (such as adventure travelers and cavers).

Those with occupational risks (such as wildlife professionals and researchers).

9 Bat lyssavirus present or suspected; canine rabies not present. Vaccine is recommended only for the following groups:

Travelers involved in outdoor and other activities in remote areas that might bring them into direct contact with bats (such as adventure travelers and cavers).

Those with occupational risks (such as wildlife professionals and researchers).